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General NPI Number Information
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NPI Number | 1326043522
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Entity Type | Organization
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Legal Business Name | JACKSON'S ROCKY RIDGE PHARMACY, INC
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 3346 MORGAN DR
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City | BIRMINGHAM
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State | AL
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Zip | 35216-3052
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Country | US
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Telephone | 205-822-5200
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Fax | 205-979-3666
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Provider Business Mailing Address
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Address Line | 3346 MORGAN DR
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City | BIRMINGHAM
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State | AL
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Zip | 35216-3052
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Country | US
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Telephone | 205-822-5200
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Fax | 205-979-3666
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRAD F JACKSON
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Credential | PHARM D
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Telephone | 205-822-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 111519
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License Number State | AL
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